【摘要】 目的探索直视微创下获取冠状动脉搭桥的备用移植血管的外科方法。方法 32例冠心病患者接受冠状动脉旁路移植术(CABG),全部采用直视微创技术获取大隐静脉或桡动脉作为搭桥的移植血管,简称"打洞法"。3例采用体外循环不停跳下行CABG,余均在非体外循环不停跳下行CABG。5例取左侧桡动脉和下肢大隐静脉,余仅取下肢大隐静脉。结果从下肢多个小切口寻找大隐静脉容易;所取上段大隐静脉内膜厚、内径粗大;缝合简单,术后刀口无渗液、无愈合不良,下肢浮肿少见。术后4 d内拔除上下肢皮下负压引流管,无皮肤紧皱感,膝关节活动不受影响。所有患者术后7～15 d康复出院。结论 "打洞法"取冠脉搭桥移植血管是一种经济实用的微创外科技术。更多还原

【Abstract】 Objective To explore the feasibility and the clinical effect of an open minimally invasive method to achieve grafts for coronary artery bypass surgery(CABG).Methods Thirty-two patients diagnosed as having coronary artery disease underwent the CABG.All the grafts of both great saphenous vein(GSV) and radial artery from patients themselves were acquired by direct-view multiple small incisions.We called the surgical technique briefly as "punch hole" method.The surgeries were performed on-pump in 3,and off-pump in the others.Five patients contributed their left radial arteries and GSVs,and others supplied only GSVs as grafts.Results Multiple incisions made it easy to search for the GSV and suturing.Superior GSV from thigh was thicker in intima and wider in diameter than inferior GSV from crus.Draining removing time was less than 4 days after operation.No wound infection or indolence in limb incisions was found.Edema was seldom seen in limbs.The patients had no local tense feelings in limb incisions and no discomfort when they moved knuckles.The postoperative hospital stay was 7 to 15 days.Conclusion "Punch hole" method for achieving the grafts of CABG is an economic,practical and minimally invasive surgery,which is worthy to be further applied.更多还原